Abnormal cervical lymph nodes in multiple sclerosis: a preliminary ultrasound study
Cervical lymph nodes are the first drainage stations of the brain and therefore play a key role in neuroinflammatory disorders such as multiple sclerosis.
The aim of this study was to evaluate, by using ultrasound imaging, cervical lymph nodes in patients with multiple sclerosis and to ascertain if such patients have any clinical features to attest their role.
We enrolled 43 patients affected by relapsing–remitting multiple sclerosis (22 drug free and 21 under treatment with natalizumab or fingolimod), who underwent ultrasound examination. The morphology, diameters and volume of cervical lymph nodes were measured. We evaluated also a control group of 20 healthy volunteers.
Between-group comparisons showed that the mean anteroposterior diameters in the cervical lymph nodes on both sides of the neck were significantly different (χ 2 = 19.5, p < 0.001 for right; χ 2 = 20.0, p < 0.001 for left). Post hoc contrasts showed that the mean anteroposterior diameters were greater both in drug-naive (mean ± SD 0.66 ± 0.20 cm; p < 0.001) and treated patients (0.55 ± 0.24 cm; p < 0.001) compared to healthy individuals (0.36 ± 0.19 cm). Moreover, significant difference (p < 0.001) was shown on comparing the mean volume of the cervical lymph nodes on both sides of the neck in the studied groups. No significant differences emerged between the drug-free and treated patients.
The abnormalities shown by ultrasound in cervical lymph nodes are related to deep ones and independent of the ongoing treatment, suggesting a relationship between lymphatic drainage and disease pathology.
KeywordsCervical lymph nodes Multiple sclerosis Ultrasound
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
This study has not received grant or funding.
Informed consent was obtained from all individual participants included in the study.
- 2.Liu NF, Lu Q, Jiang ZH, Wang CG, Zhou JG (2009) Anatomic and functional evaluation of the lymphatics and lymph nodes in diagnosis of lymphatic circulation disorders with contrast magnetic resonance lymphangiography. J Vasc Surg 49(4):980–987. https://doi.org/10.1016/j.jvs.2008.11.029 CrossRefPubMedGoogle Scholar
- 5.Phillips MJ, Needham M, Weller RO (1997) Role of cervical lymph nodes in autoimmune encephalomyelitis in the Lewis rat. J Pathol 182(4):457–464. https://doi.org/10.1002/(SICI)1096-9896(199708)182:4<457:AID-PATH870>3.0.CO;2-Y CrossRefPubMedGoogle Scholar
- 7.Rennels ML, Gregory TF, Blaumanis OR, Fujimoto K, Grady PA (1995) Evidence for a “paravascular” fluid circulation in the mammalian central nervous system, provided by the rapid distribution of tracer protein throughout the brain from the subarachnoid space. Brain Res 326(1):47–63CrossRefGoogle Scholar
- 14.Johnston M, Zakharov A, Papaiconomou C, Salmasi G, Armstrong D (2004) Evidence of connections between cerebrospinal fluid and nasal lymphatic vessels in humans, non-human primates and other mammalian species. Cerebrospinal Fluid Res 1(1):2. https://doi.org/10.1186/1743-8454-1-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 21.Decimo I, Fumagalli G, Berton V, Krampera M, Bifari F (2012) Meninges: from protective membrane to stem cell niche. Am J Stem Cell 1(2):92–105Google Scholar
- 26.Sospedra M, Martin R (2005) Immunology of multiple sclerosis. Annu Rev Immunol 23:683–747. https://doi.org/10.1146/annurev.immunol.23.021704.115707 CrossRefPubMedGoogle Scholar